Does Medicaid Cover ER Visits?

In this article...
  • Does Medicaid cover ER visits? Find out about coverage for emergency care nationwide as well as the variation between states for Medicaid beneficiaries.

Medicaid provides health insurance coverage for millions of low-income people. Federally funded and administered at the state level, Medicaid programs vary somewhat by state in what they cover, what they pay for services and eligibility requirements. As a rule, all necessary medical services are provided for under standard Medicaid coverage, including emergency services at the hospital.

Does Medicaid Cover ER Visits?

Medicaid beneficiaries are able to visit emergency departments at hospitals all over the country. Standalone emergency and urgent care centers may or may not accept Medicaid for payment. Any medical facility in the United States that offers emergency care and accepts Medicaid as a payment option typically allows people with Medicaid to receive care at its emergency department.

Who Is Covered by Medicaid?

Medicaid eligibility criteria vary between states, but the Medicaid program is intended primarily for people who can't get adequate health insurance without it. State programs usually set a maximum income and asset level for beneficiaries, which are typically based on the federal benefits rate. In states with a high cost of living, you may qualify for Medicaid while earning up to 300% of the federal poverty line. In some states, pregnant women are automatically eligible for Medicaid services, as are recipients of SNAP, WIC, SSI/SSDI, housing vouchers and other income-dependent benefits.

What Does Medicaid Pay For?

Medicaid programs in every state pay for all necessary medical care. While some treatments, prescription medications and elective procedures are not covered, Medicaid beneficiaries can generally receive any tests or treatments a doctor decides they need. If you earn more than the Medicaid minimum but less than the maximum amount allowed, you may be required to pay a part of your bill as a share of cost. Medicaid benefits can ordinarily only be used at facilities that are authorized to bill Medicaid, but exceptions can sometimes be made for emergency care when no other option is immediately available.

Medicaid for ER Visits

People with Medicaid coverage can call for an ambulance to transport them to the emergency room just like people with any other insurance coverage. Medical interventions performed during the drive, such as oxygen or IV fluids, are also provided for by normal Medicaid coverage. Emergency admissions through the waiting room or walk-in station are also covered.

Medical tests and procedures ordered by ER staff are usually paid for by Medicaid, as are any other necessary costs, such as inpatient admission to the hospital, medication administered or prescribed by the doctor and durable medical equipment issued during the visit, such as crutches. Under some circumstances, Medicaid also pays for non-emergency transportation home from the hospital, provided a doctor certifies its necessity.

Will Medicaid Pay for ER Visits Out of State?

It can be a challenge to get Medicaid to pay for any health services delivered outside of the state where you're enrolled, but it can be done for some emergency care. Each state sets its own rules about paying for care delivered outside of its borders, and most either refuse to pay for non-emergency care, pay a lower rate than in-state providers get or compel out-of-state providers to enroll with their own Medicaid program to get paid for services they perform. Hawaii, for example, generally refuses to pay for any health care delivered in another state while Vermont designates reasonably large areas of neighboring states as open to its own Medicaid enrollees without restrictions.

Every state makes an exception to the exclusion rule in the case of a truly life-threatening emergency. If you have such an emergency while traveling in another state, a doctor at the emergency department you visit must sign off on a statement that your life was at risk and that travel back to your own state would have jeopardized your condition.

If this is the case, you are typically required to return to an enrolled facility in your own state as soon as you safely can. If your condition was not genuinely life-threatening, such as a broken foot bone or a burn on the hand, you might be required to pay the full cost of your treatment out of pocket unless you return to the state where you're enrolled for treatment there.

Does Medicaid Cover Immediate Care?

Immediate care is an intermediate level of care that falls between emergency and outpatient services. Immediate care is sometimes called urgent care, and it is often delivered at relatively small private clinics. Medicaid does not automatically pay for urgent care visits. To be covered, the clinic must be enrolled as an authorized Medicaid biller in your state, and a doctor at the clinic must certify that your visit was a medical necessity that fell between an elective office visit and a serious emergency requiring ER care. This is not very common for most people, which means many urgent and immediate care clinics do not accept Medicaid for payment.

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